Cardiac Catheterization - Cardiovascular Associates of Maryland

What is cardiac catheterization?

Cardiac catheterization is a diagnostic procedure performed by a cardiologist to evaluate certain types of heart disease. A thin plastic tube (called a catheter) is inserted into a blood vessel, usually in the leg but sometimes in the arm. The catheter is advanced through the blood vessel to the heart where pressures can be measured. Dye is injected through the catheter to allow the cardiologist to visualize the coronary (heart) arteries and structure of the heart. This is called angiography.

The procedure typically takes less than an hour, but may take up to two hours if angioplasty needs to be performed to open a blockage.

Why Is It Performed?

Cardiac catheterization provides information about:

Blockages of the arteries that supply blood to the heart

Function of the heart valves and other structures

Pressures within the heart

The heart’s pumping ability

This information can help doctors decide what treatment is most appropriate. The options might include:

No treatment (if the catheterization is normal)

Medication

Coronary angioplasty, with or without placement of stents

Coronary angioplasty is a non-surgical procedure that involves advancing a balloon through a catheter into a particular heart artery where a blockage exists. The balloon is inflated to compress the blockage and open the artery.

A stent is a small steel spring delivered with an angioplasty balloon that is left in the artery to keep it open.

Cardiac Catheterization Procedure

Step 1: Before

Do not eat, drink, or smoke for several hours before the test. If your test is in the morning, begin your fast after midnight the night before. If your test is in the afternoon, you may have a light liquid breakfast such as fruit juice or tea.

Take your usual medications, especially aspirin, with a small amount of water the morning of the procedure. If you are allergic to aspirin, please talk to your doctor about Plavix as an alternative. If you take medication for diabetes, do not take the medication before your procedure unless instructed to do so by your cardiologist.

Be sure to tell your cardiologist if:

You ever had a reaction to x-ray dyes, antiseptics, anesthetics, or any drugs

You are taking an anticoagulant medication such as Coumadin, which should be stopped at least 4 days before this procedure

If you are a diabetic

If you have kidney problems

If you’ve had an elevated temperature within 24-hours of the procedure

Step 2: Preparation

When you arrive at the hospital, you will be taken to the preparation/recovery area where a member of the staff will do the following:

Take a brief medical history

Insert a small intravenous catheter (IV) into your arm vein for administration of medications or fluids

Answer any questions you may have

Next, you will be moved to the catheterization laboratory, which looks like an operating room. You will lie on a special table that allows an x-ray camera to rotate around you. In preparation for the procedure:

Your groin or arm will be scrubbed with an antiseptic and shaved if necessary

You will be covered with sterile drapes

You will receive a sedative to help you relax

Step 3: The Procedure

Local anesthesia will be administered over the artery where the catheterization is to be performed. The local anesthetic may cause a slight sting or burning sensation that lasts only a few seconds.

A small puncture is made in the artery and a sheath (plastic tube) is inserted. The catheter is then painlessly advanced through the sheath to the heart arteries for dye injections, x-ray pictures, and pressure measurements. You may experience a flushing feeling with these injections but should feel no pain.

After reviewing your x-ray pictures, the cardiologists will choose one of the following treatment options:

Coronary angioplasty

End the catheterization and remove the catheter

This option will be chosen if:

Your arteries do not have significant blockages

Your cardiologist must discuss your treatment options with you, which may include surgery

Step 4: If Coronary Angioplasty Stent is Performed

If the catheterization shows blockages within your coronary arteries, your cardiologist may choose to open these blockages through the catheter. This process is called coronary angioplasty and may involve placement of a stent.

Angioplasty with or without stent implantation involves advancing a non-inflated balloon or stent though a catheter and down the artery to the exact location of your blockage, where it is inflated, compressing the blockage against the wall of the artery. When the balloon or stent is inflated, blood flow to your heart is temporarily interrupted and you may experience a brief period of discomfort. Every effort will be made to minimize this discomfort.

Step 5: Recovery

Removal of the catheter sheath

After the catheterization the sheath is removed. This can be done in the catheterization laboratory or in the recovery area. After the sheath is removed, bleeding at the puncture site is prevented in one of two ways:

A member of the team applies hand pressure from 5 to 30 minutes. This may be followed by placement of a sandbag on the groin to maintain some pressure over the entry site to prevent later bleeding. Patients are usually required to remain in bed from 5 to 8 hours.

OR

A closure device is inserted into the puncture site by the cardiologist in the catheterization laboratory. This allows you to get out of bed earlier and may not require a sandbag. Though more convenient for the patient while in the hospital, the use of this device requires some special care at home. A small lump may persist at the catheterization site for up to a month.

Discussion of findings

The doctor will come into your room to discuss the findings with you and, if you wish, your family members. You will be told whether further therapy is necessary. Further therapy may involve additional medications or even cardiac surgery. If surgery is recommended, it is usually scheduled for another day.

Step 6: After You Go Home

When you return you can expect to see a bruise or lump develop at the puncture site and remain for a week or more. This is normal. If there is extensive bruising, some discoloration and tenderness may last for several weeks. You should notify your doctor if you have new bleeding, increasing tenderness, redness or drainage from the puncture site, fever, chills or change in color or feeling in the limb used during the catheterization.

If a closure device was used, a plastic covering will be left over the site. This covering should be replaced daily after showering for the first three days. For the next four days, this site should be cleaned daily with a mild soap and covered with a clean band-aid. You can shower but not bathe for this period of time.

When to Return to Work

If you had an elective catheterization without angioplasty, you should expect to take the day off after the procedure. If you have special needs, please discuss them with the doctors or nurses before you go home. If you had an angioplasty or stent placement, you must clarify with your doctor when he/she has released you to return to work.
Also, ask the physician when you can resume exercising.